Vascular Zone Matters: Clinical Outcomes of Arthroscopic Meniscal Repair in Red–Red, Red–White, and White–White Tears

Objective: Meniscal repair is superior to meniscectomy in preserving knee biomechanics and preventing degenerative progression. However, the healing potential may differ depending on the vascular zone. This study aimed to compare the clinical and functional outcomes of meniscal tears located in distinct vascular regions. Materials and Methods: A retrospective review was conducted on 118 patients who underwent arthroscopic meniscal repair between 2015 and 2025, with a minimum 12-month follow-up. Tears were categorized as red–red (RR, n=42), red–white (RW, n=53), or white–white (WW, n=23). Outcomes were assessed using IKDC, Lysholm, and VAS scores. Return-to-sport time, patient satisfaction, and complication rates were also analyzed. Group comparisons and multivariate logistic regression were performed to determine independent predictors of failure. Results: At the 12-month follow-up, functional scores were significantly higher in the RR group (IKDC 89.3; Lysholm 91.7) and VAS scores were lower (1.8) than in other groups (p<0.001). The mean return-to-sport time was shorter in RR tears (5.8 months) than in RW (6.4) and WW (8.2) groups (p<0.001). Satisfaction was highest in RR (90.5%) and lowest in WW (60.9%) tears (p=0.004). Complications were least frequent in RR (14.3%) and most common in WW (39.1%; p=0.03). WW localization independently predicted repair failure (OR=4.98; 95% CI: 1.88–13.18; p=0.001). Conclusion: Meniscal repair outcomes vary according to vascular zone. RR-zone tears achieve better function, faster recovery, and fewer complications, whereas WW-zone tears have a higher risk of reoperation. Vascular zone evaluation should guide surgical decision-making.